Provider Demographics
NPI:1578992806
Name:DRX WA URGENT CARE PROVIDERS PLLC
Entity Type:Organization
Organization Name:DRX WA URGENT CARE PROVIDERS PLLC
Other - Org Name:IMMEDIATE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JEROMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SJOLSETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-818-3079
Mailing Address - Street 1:9000 HOLMAN RD NW
Mailing Address - Street 2:SUITE A1
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3418
Mailing Address - Country:US
Mailing Address - Phone:206-706-9001
Mailing Address - Fax:
Practice Address - Street 1:23131 BOTHELL EVERETT HWY STE B
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9362
Practice Address - Country:US
Practice Address - Phone:425-483-3335
Practice Address - Fax:425-483-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8915133Medicare Oscar/Certification